– occurs in 3-5% of all pregnancies, most common malpresentation, sometimes can get baby to turn; incidence is related to gestational age
(more common in preterm baby); more risk of breech with multiples; more likely if hydramnios
o
Types of Breech
Frank
– most common, legs up in front of face
Footling
– foot is coming out
Complete
– baby is sitting Indian style
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Breech babies are more liked to have congenital anomalies
Risks:
o
mom – more tears
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Baby – trauma to presenting part
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Prolapsed cord – greater risk if baby is breeched;
put mom’s head of bed back so baby hopefully moves back
C/S
What to do for
malpresentation?
o
May try an external cephalic version (ECV) – goal is to prevent a C/S
Deliberately altering fetal position; can be done externally or intrauterine
Relax uterus & try to get baby to turn head down
Give Mag Sulfate or Terabutline
Externally
Done at 37 weeks’ gestation because may induce labor
DO NOT want water to break so need intact membranes and normal amount of amniotic fluid
Reactive NST to make sure baby is ok
Presenting part not engaged
Macrosomia baby
:
>8.5 pounds/ 4,000 grams
o
Most common complication is shoulder dystocia
43
o
McRoberts
Position
– pull knees closer to chest; widens the angle of the pelvis for delivery
o
Risks
Complicated labor
Trauma to mom – lacerations
Trauma to baby –
Clavicle breaking
Heals on its own
Erb’s palsy- trauma to side of body that had to pulled
Usually temporary
May require physical therapy
Non-reassuring fetal status/fetal distress
o
Notable clues:
decreased FHR (fetal heart rate)
meconium stained fluid
What to do?
o
Place mom on her side – preferably left side
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Give oxygen to mom
o
IV fluids to mom
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Monitor baby
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Prep for delivery
Assessment of fetal well-being/development/maturity in pregnancy (to include various procedures implemented)
Assessment of fetal wellbeing:
Indications for testing
Age of Mom (younger or older)
Maternal Conditions (HTN, DM)
Rh Isoimmunization (sensitized to Rh factor, antibodies, baby is at risk for hemolytic disease of the newborn)
Hx. of stillbirth (concerned, may need special testing)
o
IUGR (intrauterine growth restriction) (>42 weeks gest.)
Amniotic Fluid Concerns (oligiohydramnios, polyhydramnios)
Multiples (increases risk)
Abnormal test results during pregnancy (red flags)
Normal newborn assessment findings (to include V.S., Apgar, skin, physical characteristics, reflexes, stools,
weight gain/loss, gestational age determination, etc.
Review NB
information from lab day)
Apgar 1 and 5 minutes 0-3 severe distress
Normal pulse
:
120-160 (low as 100 during sleep, high as 180 during crying)
Respirations:
30-60, brief periods of apnea
Temperature
97.5-99 (Axillary
B/P
:
90-60/50-40 mm Hg at birth
o
Maintain clear airway, neutral thermal environment
Within one hour of birth: single injection of vitamin K to the vastus lateralis muscle
Ophthalmic erythromycin ointment to prevent
eye infection from
gonorrhea
or Chlamydia, which can cause blindness
Within one hour of birth
Signs of neonatal distress
:
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